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Labour and birth—third stage

What is the third stage of labour?

The third stage of labour is the period after the baby is born until delivery of the placenta.

This stage usually takes about 10 minutes but can take up to an hour. During the third stage it is usual to have some bleeding while the placenta separates from the uterus. Mostly this bleeding is minimal, but there is a small risk of excessive bleeding called ‘postpartum haemorrhage’.

Management of the third stage of labour can occur in two ways: physiological (or expectant) management and active management. Mater Mothers’ Hospital recommends active management of third stage as it has been shown to reduce the risk of postpartum haemorrhage.

Active management

After discussion with you, your midwife will give you an injection in your thigh, just as the baby is born, or very soon after birth. The injection is the same hormone that is produced by the brain to make the uterus contract and therefore helps the womb to contract and prevent a postpartum haemorrhage.

Expectant management

In physiological or expectant management of labour the placenta detaches from the uterine wall and is delivered without intervention or medication to make your uterus contract. Blood loss may be greater where there is physiological management of the third stage.

While we respect your decision there are some circumstances where you will be strongly advised to choose active management. Some of these include any situation in which the risk of bleeding is higher, such as a long or induced labour, assisted vaginal birth, anaemia or previous postpartum haemorrhage.

The umbilical cord and cord clamping

In active management of the third stage, you can still decide whether you would like early or delayed cord clamping.

If you choose to donate your cord blood to the Queensland Cord Blood Bank they will contact you shortly after the birth. Active management of the third stage with immediate cord clamping increases the chance of a usable volume of blood for storage.

Retained placenta and postpartum haemorrhage

Sometimes the placenta does not separate from the uterine wall completely nor is wholly expelled from the uterus. This is called a ‘retained placenta’ and can cause a significant amount of blood loss if not treated immediately. Treatment includes further medication to help the uterus contract and expel the placenta. Infrequently, it is necessary to have a regional anaesthetic (e.g. an epidural) or general anaesthetic and then surgical removal of the placenta.